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In epidemiology, a non-pharmaceutical intervention (NPIs) is any method to reduce the spread of an epidemic disease without requiring pharmaceutical drug treatments. The US Centers for Disease Control and Prevention (CDC) points to Personal NPIs, Community NPIs and Environmental NPIs.[1] NPI have been recommended for pandemic influenza at both local[2] and global levels,[3] and studied at large scale during the 2009 swine flu pandemic[4] and the COVID-19 pandemic.[5][6]

Examples

Choosing to stay home to prevent spreading symptoms of a potential sickness, covering coughs and sneezes, and washing one's hands on a regular basis are all examples of non-pharmaceutical interventions. [7] Another example would include administrators of schools, workplaces, community areas, etc., taking proper preventive action and reminding people to take precaution when need be in order to avoid the spread of disease. [8] Most NPIs are simple, requiring little effort to put into practice and if implemented correctly, could save millions of lives.

Everyday examples of NPIs include exercise, sleep, yoga, healthy dietary patterns, proper cleanliness, wearing a mask, covering one's mouth while sneezing/coughing, throwing away trash rather than letting it sit around, etc. Such actions can be beneficial not only toward our health, but also the environment around us. Ensuring that our space is properly cleaned and not covered in waste helps reduce bacterial buildup and thus, lower the risk of catching a disease. [9]

Other conditions

NPIs can also be applied to more serious health conditions, such as hypertension, a chronic condition that has become an epidemic as there are no effective and safe drugs that cure the condition without significant adverse events. There is increasing evidence that non-pharmaceutical, plant-based diet in combination with physical activity can reduce high blood pressure as effectively as the most potent pharmaceutics.[10][11] There are several plant-based diets of varying efficiency. The rice diet is a low-sodium, low-fat diet composed mainly of rice and fruit and improves renal problems and hypertension. The Dietary Approaches to Stop Hypertension (DASH) has been introduced in mid-1990s. It is a diet high in fruits and vegetables and low in both saturated and total fat, reducing both systolic and diastolic blood pressure by 5.5 and 3.0 units, respectively.[12][13]

Neurodegenerative disorders, such as Alzheimer’s disease, cause dementia, i.e. severe cognitive decline. Worldwide, around 50 million individuals suffer from dementia, i.e. deterioration of cognitive function.[14][15]

Majority (~70%) of dementia results from Alzheimer’s disease, a progressive neurodegenerative pathology that causes neuronal and synaptic loss, brain atrophy, and death. Despite tremendous basic and clinical research and multibillion investments, the achievements on the preventive and curative fronts in the battle against Alzheimer’s disease have been disappointing[16][17] The number of AD patients is steadily increasing and will become a global epidemic unless effective treatments are developed. Currently there are no disease-modifying drugs for Alzheimer’s disease. Only four compounds have been approved by FDA that are used for symptomatic treatment, i.e., donepezil, rivastigmine, galantamine, and memantine.[18] Hundreds of drug candidates have failed at various stages of clinical trials.[19][20][21]

COVID-19

COVID-19 is a new corona virus that appeared in China in 2019 and has since had a tremendous impact on public health worldwide.[22] Effective vaccines are being produced by several pharmaceutical companies such as Pfizer and Moderna.[23][24] Before the vaccines get approved by FDA and reach the public, effective implementation of non-pharmaceutical intervention is key to mitigation of infections and reduction of COVID-19-related mortality. There is evidence that the most effective strategies to reduce infection are the use of face masks and social distancing.[44-46] Many states of the U.S, have introduced mandatory face mask wearing policies in public places, and there are efforts to make it a federal policy.[25]

See also

References

  1. ^ "Nonpharmaceutical Interventions (NPIs) | CDC". www.cdc.gov. 2019-06-11. Retrieved 2020-04-16.
  2. ^ World Health Organization Writing Group; Bell, D.; Nicoll, A.; Fukuda, K.; Horby, P.; Monto, A.; Hayden, F.; Wylks, C.; Sanders, L.; Van Tam, J. (January 2006). "Nonpharmaceutical Interventions for Pandemic Influenza, National and Community Measures". Emerging Infectious Diseases. 12 (1): 88–94. doi:10.3201/eid1201.051371. ISSN 1080-6040. PMC 3291415. PMID 16494723.
  3. ^ World Health Organization Writing Group; Bell, D.; Nicoll, A.; Fukuda, K.; Horby, P.; Monto, A.; Hayden, F.; Wylks, C.; Sanders, L.; Van Tam, J. (January 2006). "Nonpharmaceutical Interventions for Pandemic Influenza, International Measures". Emerging Infectious Diseases. 12 (1): 81–87. doi:10.3201/eid1201.051370. ISSN 1080-6040. PMC 3291414. PMID 16494722.
  4. ^ Mitchell, Tarissa; Dee, Deborah L.; Phares, Christina R.; Lipman, Harvey B.; Gould, L. Hannah; Kutty, Preeta; Desai, Mitesh; Guh, Alice; Iuliano, A. Danielle; Silverman, Paul; Siebold, Joseph (2011-01-01). "Non-Pharmaceutical Interventions during an Outbreak of 2009 Pandemic Influenza A (H1N1) Virus Infection at a Large Public University, April–May 2009". Clinical Infectious Diseases. 52 (suppl_1): S138–S145. doi:10.1093/cid/ciq056. ISSN 1058-4838. PMID 21342886.
  5. ^ Imai, Natsuko; Gaythorpe, Katy A.M.; Abbott, Sam; Bhatia, Sangeeta; van Elsland, Sabine; Prem, Kiesha; Liu, Yang; Ferguson, Neil M. (2020-04-02). "Adoption and impact of non-pharmaceutical interventions for COVID-19". Wellcome Open Research. 5: 59. doi:10.12688/wellcomeopenres.15808.1. ISSN 2398-502X. PMC 7255913. PMID 32529040.
  6. ^ "Report 9 - Impact of non-pharmaceutical interventions (NPIs) to reduce COVID-19 mortality and healthcare demand". Imperial College London. Retrieved 2020-04-16.
  7. ^ https://www.cdc.gov/nonpharmaceutical-interventions/personal/index.html
  8. ^ https://www.cdc.gov/nonpharmaceutical-interventions/personal/index.html
  9. ^ https://5starjanitorial.net/what-are-environmental-nonpharmaceutical-interventions-npis/
  10. ^ 10. Fontana L, Meyer TE, Klein S, Holloszy JO. Long-term low-calorie low-protein vegan diet and endurance exercise are associated with low cardiometabolic risk. Rejuvenation Res. 10:225–234, 2007.
  11. ^ Klemmer P, Grim CE, Luft FC. Who and what drove Walter Kempner? The rice diet revisited. Hypertension. 64:684–688, 2014.
  12. ^ 12. Du H, Li L, Bennett D, et al. Fresh fruit consumption and major cardiovascular disease in China. N Engl J Med. 374:1332–1343, 2016.
  13. ^ 13. Wang L, Manson JE, Gaziano JM, et al. Fruit and vegetable intake and the risk of hypertension in middle-aged and older women. Am J Hypertens. 25:180–189, 2012.
  14. ^ 21. Silverberg N, Elliott C, Ryan L, Masliah E, Hodes R. NIA commentary on the NIA-AA Research Framework: Towards a biological definition of Alzheimer's disease. Alzheimers Dement, 14:576–578, 2018.
  15. ^ 30. Nabavi, S.F.; Khan, H.; D’onofrio, G.; Šamec, D.; Shirooie, S.; Dehpour, A.R.; Castilla, S.A.; Habtemariam, S.; Sobarzo-Sanchez, E. Apigenin as neuroprotective agent: Of mice and men. Pharmacol. Res. 128, 359–365, 2018.
  16. ^ Khachaturian AS, Hayden KM, Mielke MM, Tang Y, Lutz MW, Gustafson DR, Kukull WA, Mohs R, Khachaturian ZS. Future prospects and challenges for Alzheimer's disease drug development in the era of the NIA-AA Research Framework. Alzheimers Dement 14:532–534, 2018.
  17. ^ Cummings J, Lee G, Ritter A, Sabbagh M, Zhong, K. Alzheimer's disease drug development pipeline: 2019. Alzheimers Dement (N Y) 5:272–293, 2019.
  18. ^ 24. FDA-approved treatments for Alzheimer’s: 2019 Alzheimer’s Association (https://www.alz.org/media/documents/fda-approved-treatments-alzheimers-ts.pdf)
  19. ^ Cummings J, Lee G, Ritter A, Sabbagh M, Zhong, K. Alzheimer's disease drug development pipeline: 2019. Alzheimers Dement (N Y) 5:272–293, 2019.
  20. ^ FDA-approved treatments for Alzheimer’s: 2019 Alzheimer’s Association (https://www.alz.org/media/documents/fda-approved-treatments-alzheimers-ts.pdf)
  21. ^ Elmaleh DR, Farlow MR, Conti PS, Tompkins RG, Kundakovic L, Tanzi RE. Developing effective Alzheimer's disease therapies: Clinical experience and future directions. J Alzheimers Dis. 71:715–732, 2019.
  22. ^ Li LQ, Huang T, Wang YQ, Wang ZP, Liang Y, Huang TB, Zhang HY, Sun W, Wang Y. COVID-19 patients' clinical characteristics, discharge rate, and fatality rate of meta-analysis. J Med Virol. 92(6):577-583. 2020.
  23. ^ Walsh EE, Frenck RW Jr, Falsey AR, Kitchin N, Absalon J, Gurtman A, Lockhart S, Neuzil K, Mulligan MJ, Bailey R, Swanson KA, Li P, Koury K, Kalina W, Cooper D, Fontes-Garfias C, Shi PY, Türeci Ö, Tompkins KR, Lyke KE, Raabe V, Dormitzer PR, Jansen KU, Şahin U, Gruber WC. Safety and Immunogenicity of Two RNA-Based Covid-19 Vaccine Candidates. N Engl J Med. 14:NEJMoa2027906, 2020.
  24. ^ Sharma O, Sultan AA, Ding H, Triggle CR. A Review of the Progress and Challenges of Developing a Vaccine for COVID-19. Front Immunol. 11:585354. 2020.
  25. ^ Gostin, Lawrence O.; Cohen, I. Glenn; Koplan, Jeffrey P. (2020-09-01). "Universal Masking in the United States". JAMA. 324 (9): 837. doi:10.1001/jama.2020.15271. ISSN 0098-7484.


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